The Laser Chronicles

Today we passed our 2500 treatment.  As it turned out, we did the 2500th removal session on one of our local tattooers, eJay from Saint’s and Sinner’s Tattoo.

You might ask.  Why would a tattoo artist want laser removal?  The answer is simple.  By using a laser to lighten a tattoo, we can give our clients the option to have the old tattoo covered with a better piece in as little as 2-4 treatments. Because of this, we actually have huge client base of tattoo artists.

Of course we are happy to fully remove tattoos as well.  Laser lightening is simply just one option for our clients to fix their bad tattoos with fewer treatments and by spending less money.

After spending over 4 months testing different lasers on the market, Fade Fast Laser Tattoo Removal decided to upgrade our Palomar QYAG5 to the Focus Medical NaturaLase QS 2J. With so many lasers on the market all having pretty hefty price tags it was a long, tedious and expensive process. In the end we spent over $20,000 in research costs, but the hands-on experience was worth every penny. Below is a list of the machines we tested and a bit of information on each.

Hoya Conbio’s Revlite was the first system we tested. Actually, it was the second time we had the machine in our office (we did a side-by-side comparison with the QYAG5 a year and half ago.) However, this time we treated significantly more clients. The verdict: Conbio makes good solid machines. There is a reason that both the Revlite and its predecessor, the C6, are often called the “Gold Standard” of laser tattoo removal. Overall the results were good and the local sales guys (Maxim Laser) were fantastic.

The next laser that we tested was the Lutronic Spectrum VRM III. Again, a good solid machine. Putting it through the paces, it compared very closely to the Revlite. There were several pros and cons but overall the main things that made the machine most attractive were a lower cost and a longer warranty. If we had stopped our testing at this point, I think Lutronic would have been our new machine, but we pushed forward researching more equipment.

Laser number three that came to our office was the Focus Medical NaturaLase QS 2J. This machine is unlike any other laser on the market. The hand piece allows for more settings. It has external calibration. But, the real selling point on the laser is power. It produces twice the power of both the Revlite and the Spectrum VRM III in single pulse Q-switched mode. In laymen’s terms this means faster, more effective, and ultimately less treatments for the clients. Also, because of the increased power, the NaturaLase QS 2J is twice as effective in treating blue and green ink, which has always been the shortcoming for Nd:YAG lasers.

Finally, we tested the Fotona QX Max. This laser really is in a class all its own. It’s a 1.6J machine, which means that it produces 60% more power than most of the Q-switched Nd:YAG lasers on the market. The machine is tiny and seems to be very well built. The hand piece is similar in functionality to the NaturaLase and is extremely light and ergonomic. It even has the option of a wireless foot pedal. Of all the lasers we tested, this was one of the most impressive and is still one of our favorites on the market.

It took over a month of deliberation, but in the end we chose the Focus Medical NaturaLase QS 2J. Every machine we tested would have made an excellent addition to the business, but ultimately, it is all about power. If our practice included skin tightening, acne treatments, vascular lesion treatments, etc, then we might have chosen a different machine. However, Fade Fast only does laser tattoo removal. The speed and the power of the NaturaLase 2J just can’t be rivaled.

Furthermore our decision was based on the future research, development and training that Focus Medical offered with the laser. Our technician, Allen Falkner, has visited the manufacturing facility twice, was trained to service the machine and still works closely with laser designer. What does this mean for our clients? By understanding the physics, inner workings and operational parameters of the laser, we can provide more customized treatments for our individual clients and ultimately give them better and faster results.

Update: It has been two months since we integrated the NaturaLase 2J into our business and the results have been phenomenal, but that’s not all. Due to the increased power and huge ten-millimeter spot size, sessions have been 4 to 6 times faster than our older laser. Also, compared to some 450mJ systems, such as the Medlite C3, the NaturaLase 2J can, in some cases, reduce the time per session by as much 1/10th.*

*1/10th reduction is a comparison of area treated per laser pulse – 6.5mm spot size (33.17 mm squared) to a 2mm spot size (3.14 mm squared)

For more information on the machines such as in depth comparisons, energy outputs per spot size, and final results of our trials, please feel free to contact us.

Does the sun fade white tattoos?  The answer is actually quote complex and here’s why:

First, think of tattoo ink like paint that is being used to cover a pinkish red wall. If the wall were painted black it’s highly possible that it could be covered in one coat. If it were painted white it would take numerous coats, or the case of tattooing packing in the color. (This is why covering a dark tattoo with a lighter one is almost impossible) Also, besides “masking” any underlying color of the skin, the ink is still under the body’s natural melanin. (This is why darker skinned people cannot get light tattoos)

Physics and Biology:
Just like melanin, tattoo ink will block and/or absorb radiation. Commonly white inks contain Titanium Dioxide. Ti02 in it’s natural state is white, but when it is exposed to radiation, the composition of the molecule changes giving it a bluish color. Although, this means the tattoo is actually darker, this accounts for some of the fading. Besides changing the ink color, solar radiation also causes the body to produce melanin which is on top of the ink. This tan/brown/black color obscures the ink and in turn makes the tattoo to appear less bright. Furthermore as most people know, sun exposure destroys tattoos through the body’s process of repairing the dermal and epidermal damage caused by UVA, UVB and possibly UVC radiation.

Optical Illusion
Besides all the factors stated above, the more dramatic the difference in color, the less noticeable the fading. If you look at traditional tattoos they normally have a black outline. This is done to create a visual barrier between lighter inks and natural skin tone. Without the separation the tattoo can appear to blend into the surround tissue, giving the appearance of faded tattoo. Lastly, there is ink absorption. As already mentioned the body absorbs ink over time. However, the first month after the tattoo is put into the skin, the body removes ink particles down in the lower levels of the dermis. Even if white is packed in, there is a very good chance that your body’s lymphatic system will remove enough of the white to show some fading. Does sun exposure effect the tattoo during this time? Sure, but the basic healing period is often just a factor people don’t take into account and the sun is blamed for the fading of the tattoo.

The gradient laser removal project started August 17, 2007 when Adam Walsh of Hold Fast tattooed the bars on the inside of my right arm.  We chose 9 because an approximate spacing of a half-inch seemed to work well aesthetically, and 8 treatments seemed to be a reasonable estimation to remove a black tattoo.

I began treating the tattoo on September 19, 2007.  This was of course quite soon to start the removal, but the process was as much about experimentation as it was to show my clients how the process worked. As you can see by the first treatment, the ink was quite resilient, breaking down in an uneven fashion.  This result is actually fairly uncommon, usually only seen when treating newer tattoos.  Also, in treatment number two you can see an unusual result.  The white patch on the right side of the bar was from a scab that I accidentally pulled off.  Of course total ink removal is a plus, but I could have been left with a scar.  Thankfully I was not.

Treatments three through five all went as planned with only one constant issue.  The 9th bar, and sometimes number 8, would often blister post treatment.  This was most likely attributed to heat generated by my bicep touching the area when my arm was bent.  Treatment six also went as planned with another minor problem.  Again I accidentally pulled a scab from the area.  This time however the area did not loose color.  In fact, the opposite happened.  The scab was more superficial and the underlying dermis was exposed leaving a very dark area in the tattoo.  It took a few months, but in time the epidermis regenerated and the color evened out.

Treatments seven and eight went well. I increased the energy quite a bit to knock out as much color as possible. I was a bit more aggressive than normal, but the project was nearing completion and results needed to be more dramatic if possible.  Bar number 9 is not perfect.  There is still a bit of tattoo ink left, the tissue feels slightly different and depending on ambient temperature the area will turn red at times.

The removal project ended with the final laser treatment on February 17, 2009 and the outlines tattooed on April 2, 2009.  Overall I am happy with the final product with one minor exception. As can seen in the photo, the bars that were once straight and symmetrical, have changed shape dramatically as they were progressively treated.

In time the bars will continue to fade and the outlines will soften.  So, in the future I will be updating the photo and possibly the story behind the project.

Credit and Special Thanks to Stacy Potter for the photo.

On Tuesday May 19th, 2009 Fade Fast hit an amazing milestone, our 1200th treatment! This achievement is especially significant in that every treatment was performed by Allen Falkner, not an accumulation of treatments by multiple technicians. Below is a before and after shot from our client Chris: (The 1200th treatment was done just after the right side of the photo was taken)

Below you can see a step by step series of images from untreated (top left) to the 8th treatment (bottom right). The white frosting in the last photo is actually a normal post treatment response that disappears 10-15 minutes after the procedure. Click Here for more information on frosting.

As you can see, the tattoo is not completely removed, but we are very, very close. Another thing you might notice in the first image is that Chris lost 30 pounds since we first started. Congratulations Chris and thank you for trusting us with your tattoo removal!

In a previous blog post I touched on one of the more common tattoo removal creams: Wrecking Balm  People have been asking more about it.  So I decided to do a follow up with a bit more information.

Here are the instructions: (Visit the older blog for a full breakdown of the ingredients)
(I am paraphrasing as to not violate any copyright laws)

1. The first step involves buffing the skin with Suffusion Gel and a device called the DemoMatic with Erosion Head, 3 times a week. (The device is basically a vibrator with a sandpaper end attachment)
2. The second step is to spray the area with the Demo-Brasion spray.  After 90 seconds the area is rinsed.
3. The third step is to apply the HydraVescent Cream.
4. …and lastly the fourth and final step is to apply the Branding Butter Concealer to hide your tattoo.

Essentially the process involves mechanically buffing off layers of skin and using Salicylic Acid to help further exfoliate the deeper tissue.

From Wikipedia:
Salicylic Acid - Also known as 2-hydroxybenzoic acid, one of several beta hydroxy acids (compare to AHA), salicylic acid is a key ingredient in many skin-care products for the treatment of acne, psoriasis, calluses, corns, keratosis pilaris, and warts. It works by causing the cells of the epidermis to shed more readily, preventing pores from clogging up, and allowing room for new cell growth.

The 2 main advantages that laser removal has over these topical products are:

1. Laser energy can penetrate deeper into the dermis to breakup the ink that dermabrasion/acidic peals my not be able to reach.
2. The process of laser removal involves fracturing the ink without damaging the surface the skin.

If you have any experience, positive or negative, with this or any of the other tattoo removal creams, I would love to hear the feedback.

Over the last few months Fade Fast has been testing a new product that is specifically designed for healing of tissue that has undergone laser treatments. We have now entered phase two of our trials and are looking for clients that are interested in using free samples of this product. If you would like to participate, you only need to meet two criteria:

1. You must have undergone at least one laser tattoo removal session prior. This will help establish a baseline to compare the differences in healing while using Humatirx.
2. You must be willing to answer a short survey. Either in person or by email.

So far, in phase one of the trials, we have received about an 85 percent positive response, 15% neutral and zero negative responses.

General Positive Response – Reduction of post treatment discomfort and shorten healing time.
General Neutral Response – Saw little to no difference between using Humatrix and other healing methods.

If you would like to participate in our product testing, please drop us a line or ask about it when you come in for a treatment. For more information on Humatrix, please visit Care Tech Labs website: http://www.caretechlabs.com/ctl-products-humatrix.html

Indications

Humatrix® Microclysmic Gel exhibits endothermic and biometric properties which cool traumatized tissue and aid in the homeostasis of healing. Humatrix® Microclysmic Gel provides the ultimate moisturization for burns, autograft procedures, radiation irritation, glycolic acid peel irritation, mechanical injuries, laser treatment, and chronic wound therapy. Advanced biochemical technology provides several unique benefits. First, the time release of water molecules provides the traumatized tissue a consistent level of humectancy to promote tissue regeneration. Secondly, Humatrix® provides a protein template to assist the biological regeneration of fibroblast cells necessary for wound healing. Thirdly, the cooling process of Humatrix® lowers the surface temperature 8 to 12 degrees within three minutes preventing further tissue damage caused by dehydration of cells. Humatrix® Microclysmic Gel is a bacteriostatic, protein enriched formulation designed to maintain a moist, sterile environment which promotes and accelerates cellular regeneration by replicating the natural fibro-connective template and promoting fibroblast activity, the precursor of collagen formulation. The fibron network maintains homeostasis via the product’s bio-chemical process by the addition of an analog of extracellular matrix. Humatrix® assists in the reduction of hyper-granulation, scarring, and hyper-contracture as well as increases both the extensibility and flexibility of human skin with the addition of the glycosaminoglycan matrix. Humatrix® is an excellent adjunct to wound treatment. Humatrix® maintains a sterile, moist environment for the healing of chronic and acute wounds by modulating the osmotic pressure of tissue by the timed release of moisture for cellular regeneration.

So you’re stuck with a dark tattoo. You want to get it covered but your options are limited. In most cases, your choices are bigger and darker. Well, what about lightening the piece first? Below is a great example. With just 3 laser treatments, Caleb was able to cover his old tattoo with no sign of underlying tattoo. (Click the image for close-up view…you will see NO TRACE of the old kanji!)

“His neck tattooed normally.
I didn’t notice any adverse effects from the laser treatment at all.
You do good work.”
Artist: Tom Yosenick – Fine Line Tattoos
Client: Caleb Barnard – Hold Fast Tattoos

We have several things going on right now. Testing a new post treatment gel, honing pain reduction techniques and further research into topical tattoo removal products, but today’s blog is all about results.

Of course everyone wants to see a portfolio, and laser removal technicians want to display their best work. We agree, however, there is more to laser tattoo removal than just final results. It would be fantastic if tattoos were removed in just one session, but that’s rarely the case. So, what should you expect after one, two, three treatments? Below is a collection of photos in different stages of removal.

Click Images for Larger Photos

Tattoo removal is more than just science
At Fade Fast better artwork is our passion

Some you win and some you lose, and this was definitely true for today. I’m not talking about paying taxes, but I’m sure many of you are thinking that, being that it’s April 15th. No I’m talking about today’s test of a pneumatic skin-flattening (PSF) device, the Candela Serenity PRO.

First let me say, it really is an ingenious device. It’s basically a vacuum system that pulls the skin up into a clear, disposable plastic lens. The idea is that when the skin is compressed, pain signals are blocked. In clinical tests, it appears to work amazingly well. However, these tests have focused mainly on laser hair removal. From my understanding, we were the first studio in the United States to test the unit’s effectiveness on pain reduction in conjunction with laser tattoo removal, at least the first to use the disposable hand piece.

Sadly, the results weren’t anything close to what we hoped. The unit was tested on three people. (Two clients and I also volunteered my arm and hip) Pain reduction seemed to be almost nonexistent when using the device in conjunction with our Palomar QYAG5. In fact, at times the pain seemed more intense. Here are the basic results:

Person 1: (same energy output for each test)

• Inside of forearm arm treated directly with laser to determine baseline of pain.
• Area treated with PSF – Similar pain.
• Hip treated directly with laser to determine baseline of pain.
• Area treated with PSF – Similar pain.

Person 2: (same energy output for each test)

• Buttocks treated directly with laser to determine baseline of pain
• Area treated with PSF – Similar pain, possibly slight reduction
• Area iced for five minutes and treated – Dramatic reduction of pain
• Iced area treated with PSF – Increased pain

Person 3: (same energy output for each test)

• Back treated directly with laser to determine baseline of pain
• Area treated with PSF – Increase of pain
• Area iced for five minutes and treated – Medium reduction of pain
• Iced area treated with PSF – Dramatic increase of pain

So what does all this mean? The device has proven to work with laser hair removal, but it appears to have a different reaction to laser tattoo removal. After some discussion with the representative, we may have come to a fairly reasonable, yet hypothetical conclusion.

As the device sucks the skin into the lens, the epidermis and upper levels of the dermis are compressed making the tattoo ink a much clearer target. Logically, this means the ink might absorb the energy that could be reflected and/or absorbed by the skin during a normal treatment. If this is the case, then testing the area with an identical laser energy output may not have been a true comparison. In fact, the tattoo treated with the PSF may have been absorbing a dramatically larger amount of energy.

In conclusion, although presently the Candela Serenity PRO-PSF might not be a good companion machine for tattoo removal, I am grateful that the company allowed us to be one of the first laser removal studios to test the device. Plus, if the unit becomes available again for different energy comparisons, we might be giving it another try down the line.